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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419985
Report Date: 12/02/2024
Date Signed: 12/02/2024 09:26:33 AM

Document Has Been Signed on 12/02/2024 09:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VILLAGRANA FAMILY CHILD CAREFACILITY NUMBER:
197419985
ADMINISTRATOR/
DIRECTOR:		VILLAGRANA, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 800-2610
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:23 AM
MET WITH:Licensee Laura VillagranaTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
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On 12/2/24 at 8:23 AM, Licensing Program Analyst (LPA) Jeanine Lipsey conducted an unannounced case management visit for the purpose of obtaining signatures and delivering an amended 9099D report that was created on 11/20/24 LPA met with, Licensee Laura Villagrana. Census zero.


Exit interview conducted and report was reviewed with Licensee Laura Villagrana. A copy of this report and a notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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